Sewanhaka Central High School District
Elmont Memorial High School
“A Nationally Recognized School of Excellence”
Complete both sides of this
form.
National Senior Honor Society -EMHS Candidate Information Form
Directions: Please complete all sections/pages of this form. Incomplete applications will not be considered. This
information will be used in the selection process. Completion of this form does not guarantee selection/membership.
FORM IS DUE BY 3:00 pm on Tuesday, October 13, 2015.
Part 1: Co-Curricular Activities
List three most recent activities you have been a participant in during school. Include clubs, teams, musical groups, etc., and
explain how you were an asset to each.
Activity/Club/Team/Organization
Year(s) in which Explain the ways in which you were an asset
you
Participated
1
2
3
Part 2: Leadership Positions
List the most recent leadership positions held in school, your community, or work activities. For example, elected student
representative, club officer, team captain, newspaper editor, work area manager, etc.
Leadership Position
Year(s)
Activity/Organization
Briefly explain your responsibilities
Ex
Co-Captain
Junior
JV Football
Organizing warm-up drills, communicating with
coaches, etc.
1
2
Part 3: Community Activities
List the most recent community activities (outside of school) in which you have participated and note any major
accomplishments in each. For example, Boy/Girl Scouts, Church group, volunteer groups/service, clubs/teams sponsored
outside of EMHS, etc.
Community Activity
Year(s)
Briefly explain how you participated and discuss any major
accomplishments.
Ex
Church Choir
2014Attended all practices and church services; sang at holiday
present
celebrations, etc.
1
2
Part 4: Advanced/AP Courses
List the most recent Advanced/AP Courses taken within the past two years.
Course /Yr.
Course /Yr.
Ex: 10A English
2015
Ex: 12AP Psychology
current
Course /Yr.
Part 5: Recognition and Awards
List the most recent honors or recognition that you have received which will support your bid to be selected for
membership. For example, High Honor Roll, Honor Roll, Spartan Award, Distinguished Achievement, Principal’s List, sports
awards, service awards, special recognitions, etc.
Recognition/Award
Semester/Year(s) Briefly explain how you earned this distinction.
Ex
Science Student of the Month
Spring 2015
I studied, attended extra-help, tutored my peers, earned a 90% or
above on exams.
1
2
Part 6: Required Additional Information: TUTORING
1. Tutoring is an essential part of becoming a member. Please list the subject(s) you are comfortable tutoring other
students in, as well as when you are available to tutor (before or after-school, lunch periods). All tutoring will be done at
Elmont Memorial High School. You do not have to choose more than one subject.
Subject/Subjects
Level
Availability
Example: Social Studies
Example: Global
Example: After-school
1
2
2.
Current English Teacher: __________________________________
Period: ______
3.
Please have three teacher’s sign below indicating that they support your bid for membership/selection to the
National Senior Honor Society. The teachers that you select should be able to testify to your academic
commitment.
Teacher’s Name (print)
Teacher’s Signature
1.
2.
3.
**Please see me before the due date* below if you have any questions and/or concerns about this application form.
Please sign below. Your signature indicates that as a member of the EMHS Honor Society you acknowledge all the terms,
conditions and requirements as they have been explained to you.
Print Name: ______________________________________________
Signature: _________________________________
Parent/Guardian Name: ____________________________________
(Please print)
Signature: _________________________________
*This form must be submitted by Tuesday, October 13, 2015. APPLICATIONS WILL NOT BE ACCEPTED PAST 3:00 pm ON THIS
DATE.
This form should be returned stapled to the top of your essay.